Individual provider Active NPI

Elkanah Israel Kindseth, PHARMD

  • Pharmacist
  • Normal, IL
National Provider Identifier
1851674543
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
2011023692 Issued in MO
Practice address
1114 Liberty Rd
Normal, IL 61761-1311
Phone
(309) 830-6687
Fax
(417) 532-9743
NPI assigned
Sep 20, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 2011023692 MO Primary

Addresses

Primary practice location

1114 Liberty Rd
Normal, IL 61761-1311

Mailing address

1114 Liberty Rd
Normal, IL 61761-1311
Phone (309) 830-6687

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
2011023692MOMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1851674543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 LIBERTY RD",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617611311",
            "telephone_number": "309-830-6687",
            "fax_number": "417-532-9743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 LIBERTY RD",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617611311",
            "telephone_number": "309-830-6687",
            "fax_number": "417-532-9743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINDSETH",
        "first_name": "ELKANAH",
        "middle_name": "ISRAEL",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2011023692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.